CO2 Laser in Neurosurgery: A Hands-on Experience.

Since its first use in 1963 by Engr. Kumar Naranbhai Patel, carbon dioxide (CO2) laser has evolved to attain a vital role in surgical neurology. The utilisation of laser is increasing in neurosurgery, especially minimally invasive and functional procedures. The laser serves three important functions in surgical procedures: photo-coagulation, photo-vaporisation, and photo-activation. Due to its favorable properties, CO2 laser is now recommended for many neurosurgical procedures. The development of low profile, and flexible transfer media has facilitated the use of laser in micro-neurosurgical procedures. CO2 laser has gained popularity as a unique cutting tool. The characteristic features of CO2 laser cause photo-vaporisation more than photo-coagulation. This allows to achieve a contact-free, relatively bloodless excision of many highly vascular lesions, especially helpful in critical anatomical areas. In this report, we share our first hands-on experience with flexible CO2 laser at Prince Sultan Military Medical City, Riyadh. The CO2 laser was utilised to achieve intracranial resection of a huge, markedly vascular glomus jugulare lesion. There was a significant reduction in blood loss with laser use, when compared with surgical resection utilising bipolar cautery, suction and cavitron ultrasonic aspirator. Postoperative recovery was also rapid and uneventful due to relatively less edema at surgical bed. We would like to favour the use of CO2 laser, especially when dealing with complex lesions with increased vascularity located in close relationship with vital neural and vascular structures in an attempt to minimise damage to intact tissue.